EDITORIAL
Informationists and librarians
Perhaps it’s an omen.
While in Vancouver for MLA/
CHLA/ABSC 2000, Carolyn
Lipscomb and I talked about pos-
sible themes for her history column
in this issue of the Bulletin of the
Medical Library Association. We set-
tled on clinical medical librarian-
ship (CML), a topic that has been
the subject of numerous papers over
the last thirty years and would,
therefore, provide a suitable subject
for the column. We had no idea that
Frank Davidoff and Valerie Florance
were putting the finishing touches
to an editorial for the Annals of In-
ternal Medicine that will almost cer-
tainly bring discussions of clinical
librarianship to a new level of inten-
sity [1]. You need to read it.
Librarians will quibble over the
term ‘‘informationist.’’ It has an
awkward and contrived sound, but
as a rhetorical device, designed to
get our attention, it certainly does
the trick. Some have been quick to
reply that what Davidoff and
Florance describe is what librarians
already do; we do not need another
bit of jargon to make it glitzy. The
fact is, the work they are describing
is not what librarians already do.
It should be.
The singular addition that
Davidoff and Florance make to the
development of clinical librarian-
ship is to insist on more specialized
clinical training than health scienc-
es librarians typically have, even
those who participate in clinical li-
brarian programs. Shortly after the
editorial appeared, Patricia Fortin,
who works as a clinical librarian in
Canada, made this comment on
MEDLIB-L;
although I could do summaries of
the literature for some of the ques-
tions I receive and/or identify, I
would not feel entirely comfortable
doing this without more of a clinical
background, statistical knowledge,
and/or very well-honed critical ap-
Bull Med Libr Assoc 88(4) October 2000
praisal skills. This is because what I
write could greatly impact patient
care. [2]
This is the crux of the matter.
Clinical librarianship programs
have attempted to extend the help-
ing role of the librarian to the pa-
tient’s bedside, but they have not
essentially altered that role. The li-
brarian’s sphere remains that of un-
derstanding the question, searching
the literature, providing targeted
information—clinical judgments
are left to the physicians. Perhaps
this is as it should be.
But Davidoff and Florance think
something more is necessary. They
are suggesting that the relationship
between the information-manage-
ment expert and the other mem-
bers of the health care team needs
a significant shift. They point out
that CML programs ‘‘have re-
mained largely outside the main-
stream of clinical practice.’’ They
argue that now is the time to move
them into the mainstream.
What is required to do this?
Davidoff and Florance advance two
primary causes for the failure of
clinical librarianship to ‘‘take root
and flourish.’’ Money is always a
problem, of course. Clinical librar-
ianship programs have always
been viewed as ancillary, as extras,
as things to be done if we can find
the funding—not as critical servic-
es that should be funded first.
Davidoff and Florance also point to
the ‘‘physician’s ambivalence about
needing help,’’ and they argue that
‘‘it’s time to face up to the fact that
physicians can’t, and shouldn’t, try
to do all or even most medical in-
formation retrieval themselves.’’
Perhaps there is another rea-
son—an ambivalence on the part of
librarians to take on the outlined
role. I am reminded of the contro-
versy that still accompanies the no-
tion of quality filtering. While
many of our colleagues have adopt-
ed and adapted quality filtering as
an integral part of the work that
they do, many others are repelled
by the notion, believing that to
make the sorts of required judg-
ments takes one beyond the bound-
aries of good librarianship. I imag-
ine that the notion of taking an
even more active filtering role
would be that much more appal-
ling to those who take this view.
Perhaps they will agree that what-
ever these informationists are, they
should not be called librarians.
But librarians are exactly what
they are. Librarians playing a role
that very few of us have played so
far, to be sure, but fundamentally,
librarians doing the core work that
librarians have always done: mak-
ing sure that people have the infor-
mation they need, where they need
it, when they need it, and in the
format in which they find it most
useful.
Twelve issues ago, in the October
1997 issue of the Bulletin, Nunzia
Giuse prefigured Davidoff and
Florance, arguing in an editorial
that the future of medical librari-
anship lay in moving into the clin-
ical realm [3]. She identified the
lack of adequate preparation for li-
brarians as the most important el-
ement limiting the success of CML
programs. She identified a number
of specific things that should be
done. Librarians should ‘‘assimilate
the culture,’’ ‘‘seek instruction in
the techniques of clinical trials,’’
‘‘study . . . evidence-based medi-
cine,’’ and receive ‘‘mentored in-
struction and practice in searching,
retrieving, filtering, and summariz-
ing information.’’ These elements,
and the others mentioned in her
editorial are, indeed, absolutely
critical. But in the end, Giuse’s bet-
ter-prepared (and more successful)
clinical librarian is still a library-
based librarian. The program is de-
391
Editorial
veloped in the library; the training
is managed through the library; the
funding is provided by the library.
Davidoff and Florance take the con-
cept a very substantial step further.
In their view, the informationist
takes part in a nationally recog-
nized standard curriculum, has ap-
propriate training and accredita-
tion, and will ‘‘answer directly to
clinical directors and chiefs of staff,
and their services [will] be paid for
directly, as is done for other health
care providers.’’ This model is clin-
ic driven, not library driven.
Nine months after her editorial
appeared, Giuse and her colleagues
published an article describing the
Vanderbilt CML program [4]. In
comparing it with the information-
ist piece, I am struck by the fact
that it lists ‘‘caseworkers, nutrition-
ists[, and] pharmacists’’ as models
for the role that clinical librarians
can play, while Davidoff and
Florance point out that physicians
do not ‘‘perform their own clinical
chemistries, electrocardiography,
computed tomography and the
like.’’ The former models are still
one step removed from the patient,
providing services that support the
caregivers. The latter models are
hands-on. This difference may just
be a coincidence, an accident in the
writing of the two pieces, but it
does serve to emphasize that the
informationist described by
Davidoff and Florance is not a li-
brarian with additional training in
or exposure to clinical situations.
392
This informationist is a true hy-
brid—still a librarian, but one
steeped in the clinic in a substan-
tially new way.
There is something else that
strikes me when I look at the liter-
ature. Almost all of the articles that
have been written about clinical li-
brarianship over the years stress
that good clinical librarian pro-
grams are essential for the survival
and growth of librarianship.
Davidoff and Florance’s piece is not
concerned with the survival of our
profession. It is concerned with the
survival of patients.
I do not know if the development
of informationists is good or bad
for our profession; but as a librari-
an, I know that doing something
that will enable clinicians to make
better judgments based on better
use of published information is def-
initely going to be good for pa-
tients. And when I get to the heart
of it, I seem to recall that is why I
became a medical librarian.
What should our association be
doing about this? We should be
right out in front in responding to
Davidoff and Florance’s challenge.
They call for the development of a
‘‘national program, modeled on the
experience of clinical librarianship,
to train, credential, and pay for the
services of information specialists.’’
Clearly, we need to play a central
role in this development. Obvious
partners include the Association of
American Medical Colleges, the
American Hospital Association, the
library schools, and the National
Library of Medicine. The Medical
Library Association has an oppor-
tunity to take the lead in reaching
out to potential partners to begin
the discussions and the planning
that are necessary to see what sort
of beneficial reality can be made
out of the informationist concept.
Three years have passed since
Giuse sounded the call in these
pages that to avoid moving into the
clinical realm ‘‘is to deny our fu-
ture in the information age.’’
Davidoff and Florance have now is-
sued a challenge to ‘‘everyone in-
volved in health care.’’ We should
not let one more year go by before
we respond to that challenge.
T. Scott Plutchak, Editor
University of Alabama
Birmingham, Alabama
References
1. DAVIDOFF F, FLORANCE V. The infor-
mationist: a new health profession?
[editorial]. Ann Int Med 2000 Jun 20;
132(12):996–8.
2. FORTIN P. CHAT re: are you an in-
formationist? Message to: MEDLIB-L
[email discussion list]. [2000 Jun 27].
Available email: ,MEDLIB-L@listserv.
acsu.buffalo.edu..
3. GIUSE NB. Advancing the practice of
clinical medical librarianship [editori-
al]. Bull Med Libr Assoc 1997 Oct;85(4):
437–8.
4. GIUSE NB, KAFANTARIS SR, MILLER
MD, WILDER KS, MARTIN SL, SATHE
NA, CAMPBELL JD. Clinical medical li-
brarianship: the Vanderbilt experience.
Bull Med Libr Assoc 1998 Jul;86(3):
412–6.
Bull Med Libr Assoc 88(4) October 2000